摘要
目的：观察家兔急性周围性肺栓塞肺实质的CT动态变化及其病理基础。材料和方法：采用股静脉入路注射明胶海绵制作24只周围型肺栓塞模型，随机分成4组（每组6只），分别于栓塞前/栓塞后2h、1d、3d、7d（即1、2、3、4组）行CT平扫和增强扫描，观察家兔肺栓塞的影像动态变化；处死家兔后分析其对应的病理基础改变；以病理为金标准，于CT平扫和增强影像上分别测量栓塞区和正常肺实质的CT值，采用配对t检验，比较两者之间CT值差异。结果：栓塞后2h组家兔均表现为肺少血；1d组4只见肺少血征，另1只出现马赛克征伴有近胸膜处弧形阴影；3d组4只栓塞区肺实变，1只马塞克征，1只毛玻璃样改变；7d组4只出现肺实变及梗死灶，伴有胸腔积液、胸膜增厚及肺大泡；1只肺少血征，1只局部胸膜增厚，少量胸腔积液。2h组及1d组肺栓塞区栓塞前和栓塞后平扫CT值差别无统计学意义（P>0.05），CT增强显示栓塞区栓塞前和栓塞后的CT值及CT净增值差别均有统计学意义（P＜0.01），即栓塞后的CT值明显低于栓塞前；栓塞后栓塞区和非栓塞区平扫CT值差别无统计学意义（P>0.05），而增强后CT值及CT净增值比较差别均有统计学意义（P＜0.01）；3d组及7d组栓塞区和正常肺实质的平扫和增强CT值及净增值差别均无统计学意义（P＞0.05）。结论：采用明胶海绵作为栓塞物制备家兔急性肺栓塞模型，利用CT尤其是增强CT可以观察肺栓塞后早期肺少血到栓塞后期肺实变和梗死的一系列动态变化过程，并与相应的病理改变相符合。
Abstract
Objective: To observe dynamic changes of lung parenchyma with acute pulmonary embolism(PE) in rabbit model and correlation with pathological findings. Methods: Twenty-four experimental rabbit models of acute PE were established through femoral vein using gelatin sponge as embolus materials, which were randomly divided into 4 groups. Plain and enhanced CT scans were performed before embolization and after embolization at 2h, 1d, 3d, 7d(i.e. group 1, 2, 3, and 4, n=6, respectively) to observe the dynamic changes of PE. Rabbits were killed to analyze the pathologic basis of the corresponding changes. Comparing to pathology as a standard of reference, CT numbers of the embolic areas and normal pulmonary parenchyma were measured in the standard non-enhanced and enhanced CT, respectively. Paired student t test was used to compare changes of CT values. Results: The CT findings of PE at 2h after embolization reveals areas of decreased attenuation(6/6). CT revealed pulmonary oligemia(4/6), mosaic signs associated with crescent-shaped shadow of pleura(1/6) at 1 day after embolization, and 1 rabbit showed normal. Lung consolidation was displayed in 4 rabbits after 3 days, 1 rabbit showed mosaic sign, 1 rabbit showed ground-glass change. Consolidation and infarction were displayed in 4 rabbits after 7 day, accompanied by pleural effusion, pleura thickening and lung bullae; 1 rabbit displayed pulmonary oligemia, 1 rabbit showed local pleural thickening and small amount of pleural effusion. On unenhanced CT scans, there was no significant difference between pre-embolism and post-embolism of embolic areas of the 2h and the 1 day group(P>0.05). There were significant differences of CT values and net increased CT values between preembolism and postembolism of the embolic areas(P<0.01) after 2h and 1 day. After embolism, there was no significant difference on CT values of 2h and 1 day groups between embolism areas and normal pulmonary parenchyma(P>0.05). On enhanced CT scans, there was significant difference for CT values and net increased CT values between embolic areas and normal pulmonary parenchyma(P<0.01) after 2h, 1 day; but there was no significant difference of CT values of unenhanced and enhanced of 3 day and 7 day groups respectively(P>0.05). Conclusion: The pulmonary embolism models was established by using gelatin sponge as embolus. CT, especially enhanced CT can depict the dynamic changes of the PE from pulmonary oligemia to consolidation and infarction, which were correlated well with pathologic findings.
关键词
肺栓塞 /
体层摄影术 /
X线计算机 /
模型 /
动物
Key words
Pulmonary embolism /
Tomography /
X-ray computed /
Models /
animal
柴 学;张龙江;卢光明;赵艳娥;胡小波;周长圣.
兔急性周围性肺栓塞肺实质的CT动态变化与病理对照研究[J]. 中国临床医学影像杂志. 2009, 20(11): 829-834
CHAI Xue;ZHANG Long-jiang;LU Guang-ming;ZHAO Yan-e;HU Xiao-bo;ZHOU Chang-sheng.
The experimental study of acute peripheral pulmonary embolism in rabbits:dynamic findings of CT and correlation with pathologic findings[J]. Journal of China Clinic Medical Imaging. 2009, 20(11): 829-834
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